Stages and Skills in a Counselling Session

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1.1 Identify The Three Stages In The Counselling Skills Session

As highlighted in both Egan’s Skilled Helper model and Carkhuff’s HRD methodology, a coaching or counselling session, where the objective is to achieve lasting change or to empower clients to manage their own problems more effectively (Egan, G. 1998. p.7-8), can be measured in three stages; an exploration stage, a challenging stage and finally an action planning stage or, more simply, a beginning, a middle and end.

The beginning, or exploratory stage, of a session will see the client welcomed into the secure base (Bowlby, 1984) environment of the therapy room. As stated by Carkhuff, this beginning stage will see the listener attempt to have the client explore their concerns (Carkhuff, 1971) and identify what problems, issues or undeveloped opportunities (Egan, 2002) the client may wish to present. This involves the attending physically, observing and responding. Observation of the client flows from this ability to attend and is comprised of paying attention to body language / movement, facial expression and posture. From this the listener is able to identify client emotional states and readiness for helping.

Where the client is meeting the listener for the first time a confidential contract is offered along with a discussion about any goals or concerns the client may have. It is here that discussion around the length of the session/s, the ethical body the listener operates under, the mode the listener practices, client / counsellor boundaries as well as the limitations of confidentiality will take place; the client will be made aware of the ‘safety net’ offered by the confidential environment however must also be made aware that exceptions surrounding being at risk of harm to themselves or others, money laundering, acts of terrorism, drug trafficking or any child protection issues that arise would negate this confidentiality. The listener may also discuss scenarios such as how the listener might (or might not) greet the client outside of the therapy room. The listener should also emphasise that the process is non-directional and is solely for the use of the client to explore what may be causing them distress and that this will be the foundation of all subsequent sessions. As per Mearns;

‘The opening statement will be likely to reinforce further that it is the client’s time and that they have the freedom to use it for their own needs.’ (Mearns et al, 1998. p.132).

The middle, or challenging stage, of the session is where the listener develops a rapport with the speaker by utilizing both listening and responding skills such as paraphrasing, reflecting and summarising through empathic understanding, appropriate questioning and the use of silence, allowing the listener to focus on the emotions the client is experiencing. This middle area of the session is where the client will hopefully move from a disconnected understanding of themselves to a place where they can develop an understanding of their own feelings in relation to their presented experience. Here, the listener will use personalisation reflections such as ‘You feel X because of Y’ helping the client better understand their emotions and their meanings.

The listener will have an awareness of time as the process moves towards the end, or the action planning, area of the session. Here, the listener will invite the speaker to acknowledge that they have been heard and understood by making use of a summary of the overall context of the presented material as well as ensure the speaker is in a safe place as the session ends and will, as noted by Kelly;

‘… give the client a ‘neat package’ that they can go away with, feeling understood because the summary matches their material’ (Kelly, K. 2017. p.10).

1.2 Explain The Importance Of Opening A Session Appropriately

If the speaker enters the session feeling vulnerable or distressed then they are likely to feel inferior or dependent upon the listener for guidance. It is important that the listener corrects any perceived power imbalance with gestures of warmth and congruence. For therapeutic movement to be realised the speaker must feel that they can trust the listener and that they can safely disclose any and all inner thoughts, feelings and fears.

The opening statement from the listener will reinforce that all content is brought to the session by the speaker and that there is no preconceived structure into which the speaker must fit, and that they, the client, have complete control over what content they wish to present. It is important that the listener demonstrates that they are solely there for the speaker and that they are worthy of their acceptance, attention and honesty. The fundamental goal of the opening session, from preparing the environment for the client, to welcoming the speaker and offering a contract, is to convey a message that the listener accepts and values the client as a human being and that not only does the listener want to understand the client’s frame of reference but that it is their wish to form an open and honest therapeutic relationship with them for as long as the speaker feels that it is worthwhile.

1.3 Define The Following Skills Which Could Be Used In A Session

  • Attentiveness & Rapport Building
  • Active Listening, Including Minimal Encouragers
  • Managing Silence
  • Empathic Listening
  • Effective Questioning
  • Paraphrasing & Summarising
  • Focusing
  • Immediacy
  • Working At An Appropriate Pace
  • Checking Understanding With The Speaker

Attentiveness & Rapport Building are the bedrock of any listener / speaker relationship. It is only in recognizing the speaker as an individual and accepting them without judgement or prejudice that the session can move forward. By being present, attentive and focused on what material the speaker chooses to bring, a connection that can be sensed by the speaker is woven into the relationship. The listener, as explained by Mahfoud;

‘… is not there trying to solve any problem, but tries to be present, welcoming the person and listening to them actively … the professional tries to be centred in the person more than in the problem’ (Mahfoud, 1999. p.53).

Active Listening can be summarised with Covey’s (1989) assertion that;

‘Most people do not listen with the intent to understand; they listen with the intent to reply. They’re either speaking or preparing to speak. They’re filtering everything through their own paradigms, reading their autobiography into other peoples lives’ (Covey, 1989. p.239).

This is where the counsellor must differ and endeavour to enter the speaker’s frame of reference by listening to how the speaker interprets and understands their own world, feelings and emotions, listening instead with the intention only to understand. Active listening is the act of intentionally focusing on who we are listening to in order to understand what is truly being said. As the listener we should be able to repeat back in our own words what has been said to the speaker’s satisfaction (it is important to point out here that this empathetic acceptance does not indicate an agreement but rather an understanding). The listener should try to experience the depth of emotions that the speaker feels by actively listening with all their senses, by thinking about what message their own tone of voice and posture carries while interpreting the body language of the client as they share their story, encouraging them to express themselves fully by the use of minimal encouragers and verbal nods during natural pauses in the clients story. As Rogers’ states;

‘If I can listen to what they can tell me, if I can understand how it seems to them, if I can see its personal meaning for them, if I can sense the emotional flavour which it has for them, then I will be releasing potent forces of change for them.’ (Rogers, 1961. p.332)

Managing Silence is defined by Feltham and Dryden as being;

‘The temporary absence of any overt verbal or para-verbal communication between counsellor and client within sessions. This may be a time when the client is digesting an experience, gathering (their) thoughts to speak or manifesting resistance to counselling’ (Feltham and Dryden, 1993. p.177).

The skill of managing silence is perhaps the most underrated of all counselling skills and is perhaps most effective in giving the client space to think about what they have shared and allowing the speaker autonomy to set a pace and content for the session that is appropriate and suitable for them. On silence, Rogers states;

‘In an initial interview, long pauses or silence are likely to be embarrassing rather than helpful. In subsequent contacts, however, if fundamental rapport is good, silence on the part of the counsellor may be a most useful device’ (Rogers, 1942. p.165).

In managing silence, the listener should be present with the speaker, within that silence, listening to the non-verbal cues that help build rapport. The listener will help the speaker explore their emotions and feelings by trusting them to find the words or images they are looking for with the use of silence. Silence will provide a space where the speaker can focus on feelings that can be nurtured within their narrative.

Empathic Listening, also known as reflective or active listening is a way of listening and responding to another person in a way that improves mutual understanding and builds trust. It is an essential tool for listeners as it enables the reception and accurate interpretation of the speaker’s message as well as the formulation of an appropriate response. Among its benefits it enables a release of emotion / tension and creates a safe environment for collaborative problem solving. William Simkin, former director of the ‘Federal Mediation & Conciliation Service’, noted that understanding is of little practical use unless the mediator can actually convey that they understand the essence of the issue… It is only then they can expect to be afforded confidence and respect (Simkin, 1971). As Rogers notes on listening;

‘We think we listen, but very rarely do we listen with real understanding, true empathy. Yet listening, of this very special kind, is one of the most potent forces for change that I know’ (Rogers, 1980. p.115 – 116).

Effective Questioning by the listener is used to clarify and check understanding with what the speaker is saying by way of open questions such as ‘how?’, ‘what?’ or ‘who?’. Questioning should be used to paraphrase more accurately and must not be intrusive or directive although, as the listener-speaker relationship reaches a depth where trust is present, immediacy can be used in combination with questioning by the listener to express a feeling within them.

Paraphrasing & Summarizing are used to outline the main essence of emotions and feelings that are emerging from the speaker’s narrative. It is used to clarify these emotions and feelings in the listener’s own words and to act as a review of what work has been done to that point and, can be the start of prioritizing and focusing the speaker’s thoughts and feelings on the central issues. The use of paraphrasing, simply changing the words of the speaker into the words of the listener without changing the emotional depth, is a powerful tool and indicator to the speaker that their emotions within their presentations are being heard and felt by the listener.

Focusing is the tool used to home in on what the speaker is bringing and choosing an area to bring to light, inviting the client to explore in more depth an area where the listener feels the focus should be. It is particularly useful when the listener has heard the client’s presentations and wishes to ‘clear away’ some of the surrounding material and focus down onto the central issues. This involves thinking through the implications of prioritising; which issues need swift action? If one issue is dealt with first, how will this impact other issues? What will this mean for the client? This may be an area where the listener looks inwardly at their own level of experience as a counsellor and examines their competence as to whether they need to refer the client on.

It’s important that during this period of ‘prioritising’ that the listener remain in the client’s frame of reference… Within person-centred counselling it would not be applicable to stop the client dead and focus on one word or feeling immediately; it would be presented as an invitation to revisit that word or feeling (where the client is ready and able to do so) through reflection or summary.

Immediacy is the ability of a counsellor to use the immediate situation to invite the client to look at what is going on between them in the therapeutic relationship. Used appropriately it can reveal what is really being sensed, thought or felt and may refer to gut feelings or hunches of the listener or more specific things such as noticing when a client clenches their fists when mentioning specific details of their journey or declines to make eye contact with the listener when discussing elements of their presentations.

The nature of immediacy means that its use is risky; the ‘gut feeling’ of the listener may not be correct and may often relate to difficulties between the therapeutic boundaries in the relationship such as a listener as a POC relaying issues around racial discrimination in the workplace to a caucasian listener or a female client discussing trust issues in men with a male listener. Although these ‘gut feelings’ may sometimes be incorrect, as Rogers highlights on immediacy;

‘I have come to recognise that being trustworthy does not demand that I be rigidly consistent but that I be dependably real’ (Rogers, 1989. p.119).

Working At An Appropriate Pace for the client is vital and shows a respect for the client as a person, something clearly highlighted within the BACP Framework (2018). Brems also explains that counsellors;

‘… must practice patience and accommodate a client’s pace in counselling’ (Brems, 2001. p.21).

Some clients will come to counselling completely overwhelmed or lost and unsure of what to present or say; when this happens clients can take extended periods of time to choose the best way to describe their situation or feelings. This is when the counsellor must simply be present with the client. It would be inappropriate to complete client sentences for them, try to rush them or use some other behavioural cue to encourage the client to move along quicker with their journey than they are comfortable with.

Checking Understanding With The Speaker is important in many situations, none more so than when the information being communicated is difficult or even traumatic in some way. Not only does confirming understanding back to the client show an investment by the listener in their journey but it confirms the listener is correct in their comprehension and resolves any areas of confusion or misunderstanding. As an extension of reflection clarifying understanding back to the speaker reassures them at the listener is attempting to understand the messages being expressed and is accomplished through the use of other counselling skills such as paraphrasing, asking open ended or probing questions.

 

1.4 Explain The Importance Of Closing A Session

As previously stated, all effective sessions will follow a structured beginning, middle and an end; it is during the time when contracting and informed consent is being discussed that the length of the session should be made clear to the client.

The therapist can indicate at the point of summarising how much time is left before the counselling session ends. This gently prepares the client for the termination of the session. Since the person-centred therapeutic relationship is so intimate, there may be some difficulty with ending the session, but a skilled listener will be able to manage the termination smoothly and in a way that leaves the client feeling ‘held.’ On endings within therapy Yalom states;

‘Termination is more than an act signifying the end of therapy; it is an integral part of the process of therapy and, if properly understood and managed, may be an important factor in the instigation of change’ (1975, p.365).

A summary of the speaker’s key thoughts and emotions will inform them that they have been heard and hopefully, allow a deeper experience of the listener’s empathy and understanding. The listener will be able to offer the speaker a realistic assessment of what further progress is possible, along with an estimate for how many subsequent sessions may be needed. This may require an adjustment to the initial contract as new goals may be set by the speaker.

1.5 Explain The Possible Impact Of Diversity On The Use Of Counselling Skills In A Session

A possible impact of diversity on the use of skills used in a counselling session could be that the speaker simply feels misunderstood or that the listener doesn’t really understand them. The listener will use counselling skills to focus on the speaker but, may inadvertently interpret characteristics of the listener as individualized traits, underestimating the value and strength that the speaker may place on their religion, community and social interactions. For example, because there may be a strict, role defining importance for fertility and motherhood placed on women within their cultural community, a dilemma might present where a woman who may not want children, fears family and social isolation.

The impact on this occasion is that the listener may not fully understand the significance of important characteristics within the speaker’s life or the importance that the speaker places on both their family and cultural role and so cannot fully appreciate, experience and empathies in a way that is meaningful to the speaker. As Bond explains;

‘The therapeutic challenge involves being able to understand the significance of understanding unfamiliar points of reference’ (Bond, 1993. p.199).

It is therefore important that the speaker’s diversity is adequately understood and that the process is supported with knowledge of the differences between the listener and the speaker. Conversely, stereotyping or labelling an individual because of their diversity, focusing on the difference as a characteristic or prerequisite of the speaker’s gender, sexuality, culture, ethnic group, disability, or political bias will also result in the listener not truly understanding the speaker and entering their frame of reference. For example, if a presenting speaker had a disability that clearly affected and restricted their movement, it would be all too easy to assume that this person was housebound, or socially isolated and as such, attach this assumption to their presenting material. The listener is not seeing and feeling the speaker as an individual that exists within their own diverse, social and cultural construct.

2.1 Ensure The Environment Is Suitable And Safe

Although the room was not ideal in its set up due to the limitations of availability I inspected the classroom to satisfy basic Health & Safety requirements such as checking that the doors could be closed fully and that the room would be without interruption. The lighting was not adjustable although it was a suitable, comfortable level. I ensured the blinds adjacent to the seating arrangements were closed and closed the windows to avoid traffic noise. I then arranged the speaker-listener chairs opposite and offset from each other to reflect nature of the process I wished to create. I made sure that a clock was discreetly placed within the room so that I would be able to monitor the time during the session. Although I was unable to turn the surrounding computing equipment off completely I ensured that none of it would disturb myself or the client over the course of the session. If I was to undertake another roleplay in this room again I think covering the glass panel in the door would also help as this caused several noticeable distractions when I feared somebody would enter the session (at that time of evening the only people in the building were others students on my course and the tutor themselves… Anyone having come far enough to pass the door would likely be attempting to enter, something I was aware would disrupt the session).

2.2 Open The Session With The Speaker, Explaining The Following;

  • Limits Of Confidentiality
  • What Is On Offer
  • Length Of Session

After I introduced myself to the listener, I explained who I was and that I was training in counselling skills (rather than being ‘a counsellor’) and began to outline limitations of confidentiality; I explained that although everything brought to the session would be confidential any disclosures surrounding drug trafficking, money laundering, child protection issues or indications of being at harm to themselves or others would place an obligation on me to break confidentiality and that although I failed to specify the full legalities. I then emphasised that I would not give any advice and that the session would be driven by the client themselves.

After this, I began to explain to the speaker that a 20 minute session would be available to discuss whatever they wished to present advising that I worked in person centred manner meaning the sessions would be non directive.

2.3 Develop The Session Using Skills Appropriate For The Session

I struggled greatly with the material the speaker chose to present due not only to the nature and weight of the material but also the impact the material had on the speaker earlier that evening in opening class discussions; the speaker chose to discuss a recent bereavement and childhood trauma which I knew were both still very raw to them. I became aware that guiding the speaker through these issues was not only beyond the skills I possess at this stage but that I could easily do harm by even attempting to, something which I know put me very much on the ‘backfoot’ in how comfortable I felt with practicing particular skills.

I was conscious of silent / minimal encouragers; nodding, smiling, posture etc. whilst I listened as they presented their story to me. With the use of reflecting and summarizing, I tried to outline their immediate concerns and paraphrased that the sense of loss the client felt although, again, due to the nature of the material I felt uncertain that the skills used were of any practical use and found myself wanting to simply reassure the speaker rather than listen which is in line with my solution based background.

As the session progressed, I made use of both silence and summaries, as well as offering the speaker reflections. I felt the first instance of silence went very well and gave the speaker an opportunity to realise their feelings and expand their narrative however the second instance where I tried to use silence again became almost too heavy for me and I broke it myself… Although in later feedback the speaker advised this wasn’t an issue I felt disappointed that I had not held out as I had with the first silence and again given them that opportunity to expand or reflect. I endeavoured to stay within their frame of reference although there were several instances where I felt I was acting from my own… something that I was mindful of and managed to adjust. As the session developed, I confirmed my understanding with the speaker through clarification.

2.4 End A Session Appropriately Within Agreed Time Boundaries, Showing Sensitivity To The Speaker’s Needs And Feelings

Although I initially gave the indication that the session would run for 20 minuets this was cut short due to an interruption from outside and the session ended somewhat shorter than planned… This is something I felt could have been handed better although the speaker did not seem phased and mentioned afterwards that they had not noticed the session was shortly planned. Again though I feel this could have been handled better and let me feeling like I had short changed the speaker. I did however ensure that he speaker felt safe and confident on leaving the session, offering them a summary of their presented concerns to clarify with them that I had heard and understood and that we had identified the main feeling behind their issue, in this instance the sadness / loss associated with bereavement.

3.1 Reflect On The Stages Of The Counselling Skills Session

I felt the opening stage of the session went quite well; limitations of confidentiality were explained to the speaker although I did not cover the full legalities of specific disclosures which I put down to nervousness.

I explained the person centred approach reasonably well and the speaker appeared to understand and engage with this and I remained mindful of delivering a non-directive approach.

I chose to follow the speaker’s tone in presentation as I felt that being too intense or studious with open questions would inadvertently lead the speaker into feelings of shame or remorse for their situation and felt that, due to the nature of the presented material, it would be beneficial to simply clarify an underlying feeling rather than attempt to explore a deeper rooted concern and in doing so risk causing more harm to the speaker at this stage in my development. Although my soler was generally good, I was conscious of tapping my feet which I put down to feeling intimidated by the weight of the speakers material which in places led me to offering what I know believe were opinion based responses rather than recognising, paraphrasing and focusing on the speaker’s emotions within their story. On reflection, I can see that by using silence more effectively, when I felt a need to ‘add’ to the speaker’s presentation, I could have gained control and refocused my skills.

As I started to close the session, I summarized the material bought by the speaker, and they acknowledged that the underlying feelings of frustration and sadness in regards to their presenting material were how they felt in the here and now. I feel that despite my counselling skills lack of focus in areas, and how I allowed the speakers material to affect me, I demonstrated an overall appreciation and implementation of an opening, middle and an end to the process which resulted in the speaker feeling listened to and understood. I believe that, at least in part, the speaker experienced the core conditions offered by myself.

Bibliography

  • Brems, C. (2001). Basic Skills In Psychotherapy & Counselling. Ca. Wadsworth / Thompson Learning
  • British Association For Counsellors & Psychotherapists, (2018). Ethical Framework For Good Practice In Counselling & Psychotherapy, Uk: British Association For Counselling & Psychotherapy [Internet], Available From <https://www.bacp.co.uk/media/3103/bacp-ethical-framework-for-the-counselling-professions-2018.pdf/>, [Accessed 17/11/2018]
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  • Covey, S. R. (1989). The 7 Habits Of Highly Effective People. New York. Free Press.
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  • Mearns, D & Thorne, B. (1998). Person – Centred Counselling In Action – Third Edition, London. Sage Publication Ltd.
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  • Rogers, C. R. (1961). On Becoming A Person – A Therapist’s View Of Psychology. Boston. Houghton Mifflin.
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  • Simkin, W. (1971) Mediation & The Dynamics Of Collective Bargaining. Bna Books.
  • Yalom, I. D, Leszcz, M. The Theory & Practice Of Group Psychotherapy. Basic Books.
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